Femtosecond-Laser-Assisted Paracenteses-Only Congenital Cataract Extraction: A Novel Surgical Technique Enhancing Surgical Safety And Outcome

To report a first-in-the literature main-wound-free congenital cataract extraction with Femtosecond laser-assisted anterior capsulotomy and lens aspiration. 

Congenital cataract surgery, especially in those under one year, is technically challenging due unique properties of lenticular structures. The highly elastic lens capsule and soft nucleus increase the risk of radial tear, incomplete capsulotomy and posterior capsular rupture. Conventional surgery involves creation of corneal main wound of at least 2.2mm in length, which are associated with risks of wound leak and postoperative endophthalmitis in this population.

Femtosecond laser-assisted anterior capsulotomy and lens aspiration were performed under general anaesthesia. The procedure utilized Femtosecond laser to achieve a precise, well-centered capsulotomy, without the need for a main corneal incision. Standard posterior capsulotomy and anterior vitrectomy were performed utilising 2 small paracenteses, which were then closed with stromal hydration alone.

Follow-up demonstrated a clear visual axis, stable intraocular pressure and no wound leak. No intraoperative or postoperative complication was observed. Patient was aphakic and on contact lens for refractive correction. This approach significantly minimized wound-related complications, notably wound leak and endophthalmitis, which incidence are significantly higher in congenital patients compared to adults.

Femtosecond laser technology provides a safe, precise alternative to manual capsulotomy in infants, with the added benefit of eliminating large corneal wounds and lowering the risk of wound leaks and endophthalmitis. This technique has the potential to become a standard approach in congenital ophthalmology, improving safety and long-term outcomes.